Investigating the association of bed bugs with infectious diseases: A retrospective case-control study

Abstract

Bed bugs are common urban pests. Unlike many other blood-feeding human ectoparasites, bed bugs are not known to be vectors of human infectious diseases, but clinical and epidemiological studies to directly interrogate this link have been limited. Here, we aimed to determine whether bed bugs were associated with infectious diseases in a set of infested patients presenting to emergency departments (ED) in the greater Cleveland, OH area. We performed a retrospective case-control study involving 332 ED patients with bed bugs and 4,952 control patients, seen from February 1, 2011, through February 1, 2017. Cases and controls were matched by age, sex, and the presenting ED. Additionally, data were adjusted for !20 sociodemographic variables, triage data, and comorbidities in multivariable regression analyses. Seventeen laboratory values, ten different ED and inpatient diagnoses, chest radiographs, infectious disease consults, and blood cultures were examined. The odds of bed bug infestation were significantly higher for patients that had positive blood cultures, had blood cultures growing coagulase-negative Staphylococcus, were diagnosed with pneumonia, were diagnosed with cellulitis, received an infectious disease consult, received a chest radiograph, and had higher percentages of eosinophils in the blood (P < .05 for all). Additional investigations are needed to determine whether bed bugs directly contribute to disease by transmitting causative agents, whether bed bug exposure contributes secondarily contributes to infections, or whether these associations are better explained by other environmental and social determinants of health.

Analysis of Patients With Bed Bugs in the Emergency Department

“…Patients who died in the ED (n = 28) also were not included in the analyses. This same data set has been previously examined, with manuscripts in preparation and accepted for publication (Sheele, Pritt, Libertin, & Wysokinska, 2020;Sheele, Libertin, Pritt, Wysokinska, & Pietri, 2021;Sheele, 2021aSheele, , 2021bSheele, , 2021c.…”

Activation of immune pathways in common bed bugs, Cimex lectularius, in response to bacterial immune challenges - a transcriptomics analysis

“…Although more than 40 potential disease-causing agents (bacteria, viruses, parasites) have been detected in or on bed bugs ( 19 ), and bed bug infestations are strongly correlated with the occurrence of various human illnesses ( 30 ), bed bugs are not known to vector these parasites and pathogens to humans outside laboratory settings ( 31 ). The underlying physiological and immune mechanisms responsible for the bed bugs’ vector incompetence are not well understood, hence the need to study the range and anti-parasite activity of innate immune factors in bed bugs on their vector potential.…”

Comparison of Two Different Morphological Methods to Study the Pronotum of Cimicidae: Bed Bugs, Bat Bugs, and Swallow Bugs

“…Most studies have assessed the potential role of either the cosmopolitan bed bug Cimex lectularius (Linnaeus) or the tropical and subtropical bed bug Cimex hemipterus (Fabricius) in human disease transmission. Despite the thorough investigations performed to date, the epidemiological roles of Cimicidae members as infectious disease vectors remain unclear [3], however, additional aspects for their incrimination are yet to be addressed, such as their physiology/ecology and use of cutting-edge approaches [2]. Bed bugs infestation is likely to cause illnesses [3], including behavioral, morphological, physiological distress, and economic loss [4].…”

“…Despite the thorough investigations performed to date, the epidemiological roles of Cimicidae members as infectious disease vectors remain unclear [3], however, additional aspects for their incrimination are yet to be addressed, such as their physiology/ecology and use of cutting-edge approaches [2]. Bed bugs infestation is likely to cause illnesses [3], including behavioral, morphological, physiological distress, and economic loss [4]. More than 45 human pathogens distributed in several categories including bacteria, protozoa, helminths, and viruses were found in bed bugs [5].…”